Biologic therapy for early rheumatoid arthritis: the latest evidence

Curr Opin Rheumatol. 2008 May;20(3):314-9. doi: 10.1097/BOR.0b013e3282f5fcf6.

Abstract

Purpose of review: To describe current therapeutic trials with biologic agents for early rheumatoid arthritis, analyzing clinical and radiographic outcomes.

Recent findings: The use of tumor necrosis factor-alpha inhibitors in combination with disease-modifying antirheumatic drugs early after the diagnosis of aggressive rheumatoid arthritis seems to provide increased clinical benefit over methotrexate or tumor necrosis factor-alpha inhibitors as monotherapy, with better outcomes in terms of faster and more extensive clinical improvement. There also seems to be an increased likelihood of low-disease activity in some cases even after tapering therapy. Control of radiographic progression appears to be most effective among early rheumatoid arthritis patients treated with combination tumor necrosis factor-alpha inhibitors and methotrexate, although radiographic outcomes are better with tumor necrosis factor-alpha inhibitor monotherapy than with methotrexate alone.

Summary: The addition of antitumor necrosis factor-alpha agents to traditional disease-modifying antirheumatic drugs in early rheumatoid arthritis is a novel strategy which follows the principle of early and aggressive therapeutic intervention. Results from recent trials show greater levels of disease control. The impact on long-term safety and cost-efficacy are factors which will need to be better characterized over time.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / economics
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Clinical Trials as Topic
  • Drug Therapy, Combination
  • Humans
  • Immunologic Factors / adverse effects
  • Immunologic Factors / economics
  • Immunologic Factors / therapeutic use*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Antirheumatic Agents
  • Immunologic Factors
  • Tumor Necrosis Factor-alpha